197610099-1-20-2026-31-AS-JGTN-DQHUEY-20260120143156

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610099
Report Date: 01/20/2026
Date Signed: 01/20/2026 02:36:59 PM

Document Has Been Signed on 01/20/2026 02:36 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	WYNGATE VILLA GARDENS		FACILITY NUMBER:	197610099
ADMINISTRATOR/ DIRECTOR:	CHAVEZ, OSCAR		FACILITY TYPE:	740
ADDRESS:	7634 WYNGATE STREET		TELEPHONE:	(818) 352-4270
CITY:	TUJUNGA	STATE: CA	ZIP CODE:	91042
CAPACITY: 68		CENSUS: 53	DATE:	01/20/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:05 AM
MET WITH:	Alma Espinal - Co Administrator		TIME VISIT/ INSPECTION COMPLETED:	02:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Jose Tan conducted an unannounced Required One (1) year visit at this facility today. LPA initially met with staff Ricardo Rodriguez who called the administrator and explained the reason for the visit. The co Administrator Alma Espinal arrived twenty (20) minutes later. A tour of the physical plant was conducted at 9:25 AM and the following was noted: The facility consists of five (5) buildings, each house has one main entrance. The facility had submitted and approved Mitigation Plan and Infection Plan on file.. The facility has sufficient stock of PPE in the storage room. The facility has five (5) buildings with a total of (34) shared bedrooms. Each building has their own bathrooms ranging from one (1) at building #3 up to five (5) on building #2. The facility is fire cleared for bedridden in building #2 only. Approved hospice for ten (10) residents. Common areas were inspected. All buildings has its own living room. Activity room is located on building #4 and dining area is located on building #2. Dining area was observed to be neat, clean and in proper order. The facility maintains a comfortable temperature at 74°F. There are carbon monoxide detector installed in the facility. Fire extinguishers are located all throughout the facility and last inspected on 06/20/25. The facility is equipped with emergency pull alarm and sprinkler system. (continued to LIC 809-C)

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Jose Gary Tan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/20/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: WYNGATE VILLA GARDENS	FACILITY NUMBER: 197610099
	VISIT DATE: 01/20/2026

NARRATIVE

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(continued from LIC 809)

Laundry room is located adjacent to the kitchen and was observed to be locked. Laundry detergents, cleaning agents and other toxins are stored in a locked cabinet in the laundry room inaccessible to the residents.

Food Service/Kitchen area was sufficiently stocked with two (2) days of perishable and seven (7) days of non-perishable food. Knives and sharp objects were observed to be locked and inaccessible to residents.

The residents' rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passage ways are lit.

The bathroom was checked for cleanliness and proper operation. LPA observed that there are appropriate grab bars in the showers and toilets. The hot water temperature at building # 1 measured at 129.2°F, building #2 at 134.4°F, building #3 at 118.8°F, building #4 at 145.0°F and building #5 at 108.3°F. There were enough clean linen available in the closets.

Medications were kept in a locked medication carts in the medication room. The medications were observed to be locked and inaccessible to residents. Medications were reviewed and inventoried, medication count did not tally with the record. There are multiple complete first aid kits located in the medication room.

Facility emergency disaster plan was reviewed. Facility disaster drill was last conducted on 11/10/25. A fire alarm inspection by the LAFD was last performed on 09/23/24 with validity until 03/31/27. There is no body of water in the facility. Back and front yard passageways were observed to be clear from obstruction. There is a shaded area on each building for the residents.

In addition to the physical plant inspection, residents and staff records were reviewed, LPA reviewed files of five (5) randomly selected residents. Residents files appear to be complete and updated. Five (5) staff files were also reviewed, staff files appear to be complete and updated.

Citation issued. Appeal rights discussed and given. Exit interview conducted. A copy of this report issued.

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Jose Gary Tan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/20/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/20/2026 02:36 PM - It Cannot Be Edited

Created By: Jose Gary Tan On 01/20/2026 at 12:48 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: WYNGATE VILLA GARDENS	FACILITY NUMBER: 197610099
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/20/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87303(e)(2)

Maintenance and Operation

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation], the licensee did not comply with the section cited above in 3 out of 5 bldg were above the required water temperature which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 01/20/2026
	Plan of Correction
1 2 3 4	Cleared during visit. The maintenance manager adjusted all the water temperature on the above cited bldg to within the required range.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Troy Agard
NAME OF LICENSING PROGRAM MANAGER:

	Jose Gary Tan
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/20/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2026

LIC809 (FAS) - (06/04)

Page: 4 of 5

Document Has Been Signed on 01/20/2026 02:36 PM - It Cannot Be Edited

Created By: Jose Gary Tan On 01/20/2026 at 12:48 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: WYNGATE VILLA GARDENS	FACILITY NUMBER: 197610099
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/20/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87465(a)(6)

Incidental Medical and Dental Care Services

(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1 out of 1 medicaton record reviewed, the medication did not tally with the record, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/30/2026
	Plan of Correction
1 2 3 4	Administrator agreed to re train the staff medication technician staff on Medication Records and will submit proof of training on or before the POC date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Troy Agard
NAME OF LICENSING PROGRAM MANAGER:

	Jose Gary Tan
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/20/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2026

LIC809 (FAS) - (06/04)

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